Review of Rate Increases
Cal. HSC § 1385.046
California Statutes
(
a) Upon receiving notice of a rate change, a large group contractholder that has coverage that is experience rated in whole or blended and that meets the criteria in subdivision (
e) may apply within days to have the department review the rate change to determine whether the rate change is unreasonable or not justified, consistent with this article. (
b) Upon receiving an application, the department shall notify the health care service plan of the application, and the plan shall provide the information required by the department to complete the department’s review of the proposed rate within five business days of the department’s request or as otherwise required by the department. (
c) The department shall use all reasonable efforts to complete its review of the rate change within days of receiving all the information the department requires to make its determination, and shall notify the health care service plan and the large group contractholder of its determination. (
d) A rate change under review by the department shall not be imposed before a determination is made by the department pursuant to subdivision (
c) or within days following receipt by the department of all information the department requires to make its determination, whichever occurs earlier. (
e) To apply for a review of a rate change for a particular group, at least one of the following shall apply:
(1) The contractholder has more than 2,000 total enrollees.
(2) The plan failed to provide the information required by this
article or
Section 1385.10. (
f) To facilitate review, the department may group appeals that apply to the same health care service plan and that raise similar questions about rates, methodology, assumptions, or factors. (
g) The department may contract with a consultant or consultants with expertise to assist the department in its review. Contracts entered into pursuant to the authority in this
article shall be exempt from
Chapter 6 (commencing with
Section 14825) of
Part 5.5 of Division of Title of the Government Code,
Article 4 (commencing with
Section 19130) of
Chapter of Part of Division of Title of the Government Code, and the State Contract Act (Chapter 1 (commencing with
Section 10100) of Part of Division of the Public Contract Code). (
h) This
section shall become operative on July 1, 2021.